Director, Health Care Quality ManagementPrimary Location: San Diego, CA
Additional Locations: CA-San Diego Apply
- Leads and manages all aspects of Quality programs and projects that enable Aetna to measure, monitor, and improve the quality of the care and service provided to its members.
- Consults and/or works cross functionally to influence and promote change in order to continually deliver quality service to our internal and external customers.
- Responsible for coordinating, leading, and managing multiple functional areas/units including full accountability for business/financial results related to following as appropriate: HEDIS reporting, quality of care, accreditation activities and/or member satisfaction.
64485Fundamental Components: - Assures compliance with all State and Federal quality regulations, Aetna quality standards, and National Committee for Quality Assurance (NCQA) standards.
- Ensures maintenance of accurate documentation for quality improvement activities such as HEDIS reporting, surveys, audits, peer reviews, etc.
- In conjunction with key business leaders, responsible for directing the activities of quality committees.
- Provides direction setting and leadership, with accountability for quality program(s), specialized audits, special reviews, projects and initiatives.
- Manages complex projects, people, and business priorities to achieve member satisfaction.
- Develops and implements quality improvement activities nationally and/or within an assigned region.
- Directs data collection for HEDIS and/or other quality reporting; identifies opportunities for improvement based on results.
- Influences all stakeholders to support key quality projects/programs to ensure positive solutions that deliver results.
- Consults with internal/external customers on solutions that impact Quality.
- Controls expenses while meeting operational, functional and service requirements.
- Recruits, develops, and motivates staff. Initiates and communicates a variety of personnel actions, including employment, termination, performance reviews, salary reviews, and disciplinary actions. Background Experience: - Previous experience that reflects a proven track record or proficiency in the competencies noted required.
- 2+ years of experience managing staff required.
- 5+ years of clinical and/or Managed Care experience in the healthcare industry and Quality Management required.
- Demonstrated verbal/written communication and computer skills required.
- Ability to work in a fast paced environment required.
- Demonstrated ability to plan, organize, and execute multiple functional business objectives required.
- Masters degree preferred.
- Registered Nurse (RN) licensure preferred.
- Certified Professional in Health Quality (CPHQ) or other certification a plus.
Additional Job Information: Exceptional communications skills including ability to interact with a variety of external and internal audiences including senior management. Required Skills: Leadership - Collaborating for Results, Leadership - Creating a World Class Workforce, Leadership - Creating Accountability, Leadership - Developing and Executing Strategy, Leadership - Driving Strategic and Organizational Agility Desired Skills: Leadership - Creating a World Class Workforce, Leadership - Developing and Executing Strategy, Leadership - Driving Strategic and Organizational Agility Functional Skills: Management - Management - Health Care Delivery Education: Nursing - Registered Nurse Potential Telework Position: No Percent of Travel Required: 10 - 25% EEO Statement: Aetna is an Equal Opportunity, Affirmative Action Employer Benefit Eligibility: Benefit eligibility may vary by position. Click here to review the benefits associated with this position. Candidate Privacy Information: Aetna takes our candidate's data privacy seriously. At no time will any Aetna recruiter or employee request any financial or personal information (Social Security Number, Credit card information for direct deposit, etc.) from you via e-mail. Any requests for information will be discussed prior and will be conducted through a secure website provided by the recruiter. Should you be asked for such information, please notify us immediately.
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